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Spread and epidemiology of Clostridium difficile polymerase chain reaction ribotype 027/toxinotype III in The Netherlands.
Clin Infect Dis. 2007 Sep 15; 45(6):695-703.CI

Abstract

BACKGROUND

After reports of emerging outbreaks in Canada and the United States, Clostridium difficile-associated disease (CDAD) due to polymerase chain reaction ribotype 027 was detected in 2 medium-to-large hospitals in The Netherlands in 2005.

METHODS

National surveillance was initiated to investigate the spread and the epidemiology of CDAD. Microbiologists were asked to send strains recovered from patients with a severe course of CDAD or recovered when an increased incidence of CDAD was noted. A standardized questionnaire was used to collect demographic, clinical, and epidemiological patient data. Strains were characterized by polymerase chain reaction ribotyping, toxinotyping, the presence of toxin genes, and antimicrobial susceptibility.

RESULTS

During the period from February 2005 through November 2006, 1175 stool samples from 863 patients were sent from 50 health care facilities. Of these patients, 218 (25.3%) had CDAD due to ribotype 027, and 645 patients (74.7%) had CDAD due to other ribotypes, mainly 001 (17.8%) and 014 (7.2%). Polymerase chain reaction ribotype 027 was more frequently present in general hospitals than in academic hospitals (odds ratio [OR], 4.38; 95% confidence interval [CI], 1.60-12.0). Outbreaks of CDAD were observed in 10 hospitals and in 1 nursing home. Patients infected with ribotype 027 were significantly older (OR, 2.18; 95% CI, 1.43-3.33), and significantly more patients used fluoroquinolones (OR, 2.88; 95% CI, 1.01-8.20), compared with those who were infected with other ribotypes. Clear trends were observed for more severe diarrhea (OR, 1.99; 95% CI, 0.83-4.73), higher attributable mortality (6.3% vs. 1.2%; OR, 3.30; 95% CI, 0.41-26.4), and more recurrences (OR, 1.44; 95% CI, 0.94-2.20).

CONCLUSIONS

Ribotype 027 was found in 20 (18.3%) of 109 hospitals in The Netherlands, with a geographic concentration in the western and central parts of the country. The clinical syndrome in patients with CDAD differed on the basis of ribotype. Thus, early recognition of the ribotype has benefits.

Authors+Show Affiliations

Department of Microbiology, Leiden University Medical Center, Leiden, The Netherlands.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

17712752

Citation

Goorhuis, A, et al. "Spread and Epidemiology of Clostridium Difficile Polymerase Chain Reaction Ribotype 027/toxinotype III in the Netherlands." Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, vol. 45, no. 6, 2007, pp. 695-703.
Goorhuis A, Van der Kooi T, Vaessen N, et al. Spread and epidemiology of Clostridium difficile polymerase chain reaction ribotype 027/toxinotype III in The Netherlands. Clin Infect Dis. 2007;45(6):695-703.
Goorhuis, A., Van der Kooi, T., Vaessen, N., Dekker, F. W., Van den Berg, R., Harmanus, C., van den Hof, S., Notermans, D. W., & Kuijper, E. J. (2007). Spread and epidemiology of Clostridium difficile polymerase chain reaction ribotype 027/toxinotype III in The Netherlands. Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, 45(6), 695-703.
Goorhuis A, et al. Spread and Epidemiology of Clostridium Difficile Polymerase Chain Reaction Ribotype 027/toxinotype III in the Netherlands. Clin Infect Dis. 2007 Sep 15;45(6):695-703. PubMed PMID: 17712752.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Spread and epidemiology of Clostridium difficile polymerase chain reaction ribotype 027/toxinotype III in The Netherlands. AU - Goorhuis,A, AU - Van der Kooi,T, AU - Vaessen,N, AU - Dekker,F W, AU - Van den Berg,R, AU - Harmanus,C, AU - van den Hof,S, AU - Notermans,D W, AU - Kuijper,E J, Y1 - 2007/08/06/ PY - 2007/03/10/received PY - 2007/06/03/accepted PY - 2007/8/23/pubmed PY - 2008/1/9/medline PY - 2007/8/23/entrez SP - 695 EP - 703 JF - Clinical infectious diseases : an official publication of the Infectious Diseases Society of America JO - Clin Infect Dis VL - 45 IS - 6 N2 - BACKGROUND: After reports of emerging outbreaks in Canada and the United States, Clostridium difficile-associated disease (CDAD) due to polymerase chain reaction ribotype 027 was detected in 2 medium-to-large hospitals in The Netherlands in 2005. METHODS: National surveillance was initiated to investigate the spread and the epidemiology of CDAD. Microbiologists were asked to send strains recovered from patients with a severe course of CDAD or recovered when an increased incidence of CDAD was noted. A standardized questionnaire was used to collect demographic, clinical, and epidemiological patient data. Strains were characterized by polymerase chain reaction ribotyping, toxinotyping, the presence of toxin genes, and antimicrobial susceptibility. RESULTS: During the period from February 2005 through November 2006, 1175 stool samples from 863 patients were sent from 50 health care facilities. Of these patients, 218 (25.3%) had CDAD due to ribotype 027, and 645 patients (74.7%) had CDAD due to other ribotypes, mainly 001 (17.8%) and 014 (7.2%). Polymerase chain reaction ribotype 027 was more frequently present in general hospitals than in academic hospitals (odds ratio [OR], 4.38; 95% confidence interval [CI], 1.60-12.0). Outbreaks of CDAD were observed in 10 hospitals and in 1 nursing home. Patients infected with ribotype 027 were significantly older (OR, 2.18; 95% CI, 1.43-3.33), and significantly more patients used fluoroquinolones (OR, 2.88; 95% CI, 1.01-8.20), compared with those who were infected with other ribotypes. Clear trends were observed for more severe diarrhea (OR, 1.99; 95% CI, 0.83-4.73), higher attributable mortality (6.3% vs. 1.2%; OR, 3.30; 95% CI, 0.41-26.4), and more recurrences (OR, 1.44; 95% CI, 0.94-2.20). CONCLUSIONS: Ribotype 027 was found in 20 (18.3%) of 109 hospitals in The Netherlands, with a geographic concentration in the western and central parts of the country. The clinical syndrome in patients with CDAD differed on the basis of ribotype. Thus, early recognition of the ribotype has benefits. SN - 1537-6591 UR - https://www.unboundmedicine.com/medline/citation/17712752/Spread_and_epidemiology_of_Clostridium_difficile_polymerase_chain_reaction_ribotype_027/toxinotype_III_in_The_Netherlands_ L2 - https://academic.oup.com/cid/article-lookup/doi/10.1086/520984 DB - PRIME DP - Unbound Medicine ER -